Flexible/expandable phacoemulsification tip

ABSTRACT

A phacoemulsification cutting tip, including a rigid tubular portion and a flexible and expandable tip portion located distal to the rigid tubular portion. The flexible and expandable tip portion presents an axial length and an unexpanded radius and is formed such that the axial length shortens while the unexpanded radius increases when differential pressure due to an occlusion of an opening of the flexible tip portion exists.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of U.S. ProvisionalApplication No. 62/559,914, filed Sep. 18, 2017, entitled“Flexible/Expandable Phacoemulsification Tip,” which is herebyincorporated herein in its entirety by reference.

TECHNICAL FIELD

Embodiments of the present invention generally relate tophacoemulsification surgical instruments, and more particularly relateto phacoemulsification tips designed to aspirate tissue of thecrystalline lens from the eye.

BACKGROUND

Phacoemulsification is a commonly practiced ocular surgical procedurefor removing cataracts. Cataracts, a leading cause of blindnessworldwide, occur when the natural crystalline lens of the eye becomescloudy or opacified. Cataracts are generally considered to be caused byprotein aggregation and accumulation in the natural crystalline lens,causing light scattering. The interference with the passage of lightthrough the natural crystalline lens causes images to become cloudy anddistorted, thereby diminishing visual acuity. Severe diminishment ofvisual acuity from cataracts can lead to an increase in auto accidents,falls, and other social problems. Therefore, surgical procedures,including phacoemulsification, have been developed to treat cataractsand to restore lost vision. Generally, cataract extraction surgicalprocedures enable a surgeon to remove the clouded natural crystallinelens and insert an artificial intraocular lens implant to replace thefocusing power of the removed natural lens.

The conventional phacoemulsification procedure emulsifies or fragmentsthe affected lens with the use of an ultrasonic hand-held device.Typically, the ultrasonic device includes a needle like tip, which isinserted into an incision made near the outer edge of the cornea of theeye. Once inserted, the tip vibrates ultrasonically to fragment the lensfor removal by aspiration. After the natural lens is fragmented andsubstantially removed, an artificial prescription intraocular lens isimplanted through the incision to replace the natural lens and itsfocusing power.

The hand-held device tip includes an irrigation sleeve and an aspirationchannel. The aspiration channel is housed within a hollow crosssectional area of the needle tip and is operably coupled to a source ofsuction to aspirate fluid and fragmented tissue during the procedure.The irrigation sleeve usually surrounds the needle tip and is operablycoupled to a source of a liquid such as a balanced salt solution whichis delivered into the eye to aid in flushing and aspirating lensfragments and to replace fluid withdrawn or lost from the anteriorchamber of the eye during the surgical procedure.

Phacoemulsification procedures have proven highly effective, however,more advanced or denser cataracts can cause complications. The hardnessof the lens nucleus varies greatly, but generally, the lens nucleusbecomes harder and denser as a cataract develops and progresses, thusmaking removal of the lens nucleus more difficult. The prior art hasattempted to address these concerns and provide increased efficiency.

In one conventional approach, the aspiration channel provides suction toaspirate fluid and tissue from the anterior chamber of the eye. Theaspiration of fluid draws fragmented pieces of the lens cortex andmaterial of the lens nucleus to the aspiration channel for removal.However, larger lens fragments and harder denser pieces of the nucleusmay be more difficult to aspirate through the narrow aspiration channel,which can prolong the removal process. Furthermore, the aspiration oflarger lens fragments or hard dense pieces of the nucleus can sometimestemporarily occlude the aspiration channel. An occlusion of theaspiration channel causes the vacuum level within the aspiration tubingto rise until the negative pressure generated overcomes the resistanceof the occlusion, which can cause a rapid flow increase into and throughthe aspiration channel. These issues can have negative effects,including surgery complications and damage to ocular structures.

Further, lens fragments that are too large to be or that are not yetaspirated into the aspiration channel may move about within the eye andinterfere with the surgeon's ability to see the lens and otherstructures of the eye.

Thus, there remains room for improvement in phacoemulsification devicesand to address problems that still exist in phacoemulsificationtechniques.

SUMMARY

Embodiments of the invention solve many of the above discussed problemsand include a phacoemulsification aspiration tip having a flexible andexpandable structure to encourage and facilitate the passage of lensfragments that are separated from the lens during phacoemulsification tobe aspirated into the tip and out of the eye. Embodiments of theaspiration tip structure may also facilitate or encourage aspiration offluid from the eye and fluid flow into and through the aspirationchannel.

It has been observed during phacoemulsification surgery that when aphacoemulsification tip is placed in proximity of or in contact withportions of the crystalline lens inside the eye, there is a tendency forlens fragments to move away from the phacoemulsification tip due to theultrasonic vibration of the tip. On occasion, fragments of the lens areaspirated into the aspiration tip but then move out of the aspirationtip again thereafter requiring that they be aspirated a second time orfurther times before they are actually removed from the eye. Larger lensfragments and hard dense pieces of the nucleus can exacerbate this issueand prolong the tissue removal process. Lens fragments and pieces of thenucleus not yet aspirated may circulate about within the aqueous humorin the anterior chamber and interfere with the surgeon's ability to seethe lens and other structures of the eye.

As is known to those skilled in the art, it is preferable to decreasethe time spent removing tissue from the eye and minimize interferenceswith the surgeon's ability to see the lens and other structures of theeye. Additional time spent in phacoemulsification can lead to additionalapplication of ultrasonic energy to the eye and a greater potential thatthe cells of the corneal endothelium or other structures will be damagedby excess ultrasonic energy. Furthermore, interference with thesurgeon's ability to see the lens and other structures of the eye cancomplicate the surgery and have other negative effects. Accordingly, anyimprovement made to the phacoemulsification tip to facilitate theremoval of material by aspiration from the eye is expected to minimizethe time necessary for tissue removal and reduce the interference withthe surgeon's ability to see the lens and other structures of the eye.It is expected that embodiments of the invention will minimize thetendency for tissue fragments to move about within the eye and willfacilitate the removal of lens material through the aspiration channelof the phacoemulsification tip.

According to an example embodiment of the invention, aphacoemulsification device includes at least one aspiration channel witha flexible and expandable tip. In an example embodiment, the tipincludes a woven structure extending at least partially from a distalend toward a proximal end of the expandable tip. The proximal end of thetip is operably coupled to the phacoemulsification handpiece. Thephacoemulsification device terminates at the distal end of the tip. Thedistal end of the tip can have a cylindrical shape. The distal end ofthe tip is flexible and expandable for at least a portion of its length.

According to another embodiment of the invention, the specific,expandable portion includes a woven structure that can take the form ofa cylindrical, helically wound, biaxial braid. The woven structure canbe coated with or embedded, for example, in an elastomeric polymer. Thewoven structure includes an exterior surface and an interior surface.The exterior surface covers the entire exterior circumference of thetip. The interior surface covers the entire interior circumference ofthe tip. The lumen of the tip includes the internal cavity of the tipdefined by the interior surface. The distal end of the tip forms themouth of the opening which leads into the lumen. The mouth of theopening and the lumen are in fluid communication with a suction sourceto deliver suction at the distal end of the tip.

According to another embodiment of the invention, the woven structureincludes spiral or helix shaped material. The helix shaped material isinterlaced to form the woven structure. The helix shaped material caninclude metal filaments, polymer fibers, polyaramid, para-aramid orother suitable material. The cylindrical woven structure is formed insuch a way that the length of the cylinder can shorten along the axis ofthe cylinder. As the length of the cylindrical woven structure shortens,the distal end is drawn towards the proximal end. As the length of thecylindrical woven structure shortens, the distal end expands radiallyoutward so that the radius of the distal end increases. As the length ofthe cylindrical woven structure shortens, an angle between the helixesat their crossing points increases. In general, the woven structure isformed in such a way that the distal radius of the tip increases as thelength of the tip shortens. Furthermore, the aspiration tip is formed insuch a way that aspiration of tissue fragments can cause the length ofthe tip to shorten, which can cause the distal radius of the distal endto lengthen. The woven structure has a resilient nature so that theaspiration tip tends to return to its original length and cylindricalshape following an axial shortening.

The aspiration of larger tissue fragments can cause an occlusion at thedistal end of the tip. An occlusion can cause a relative increase innegative pressure inside the lumen generated by a vacuum source. Anincrease in negative pressure inside the lumen can increase the pressuredifferential between the lumen and the exterior atmosphere. The wovenstructure can be formed in such a way that an increase in pressuredifferential between the lumen and the atmosphere causes the wovenstructure to axially shorten. The woven structure is formed in such away that axial shortening of the woven structure shortens the length ofthe tip and increases the distal radius. The increase of the distalradius of the tip is expected to facilitate the aspiration of tissuefragments that can cause an occlusion into the aspiration channel forremoval from the eye. In traditional phacoemulsification aspirationchannels, an occlusion can cause an increase in negative pressure insidethe lumen followed by a sudden outflow of fluid and tissue fragmentsfrom the anterior chamber of the eye into the aspiration channel whenthe occlusion is aspirated. The lengthening of the distal radius of theflexible and expandable tip is expected to reduce sudden outflow fromthe anterior chamber into the aspiration channel when the distal endbecomes occluded. An occlusion causes the distal radius to increase, andthe increase of the distal radius facilitates the aspiration of theocclusion. The flexible and expandable nature of the distal end allowsthe distal end to conform around an occlusion while an occlusion isaspirated, which further facilitates aspiration of an occlusion.Facilitation of the aspiration of an occlusion is expected to reducesudden outflow from the anterior chamber in the aspiration channel.

According to other example embodiments, the cylindrical woven structuremay have a structure similar to that of two interlaced opposite handedhelices or an expandable cable sleeve.

According to another example embodiment of the invention, theflexible/expandable tip is made at least partially of a resilientpolymer or elastomeric. According to this example embodiment, when thelumen diameter of the flexible/expandable tip increases the walls of theflexible/expandable tip become thinner thus accommodating the expansion.Acrylic/ethylene copolymers (AEM) fluoroelastomers (FKM) andperfluoroelastomers (FFKM) such as those manufactured by DuPontCorporation can be utilized. For example, neoprene, Viton®, Varnac®ethylene acrylic elastomer, ethylene methyl acrylate copolymer with curesite monomer, Kalrez® (FFKM) elastomer may prove useful. According toanother example embodiment, the flexible/expandable tip can be formedfrom a highly stretchable and highly resilient polymer-claynanocomposite hydrogel. Such materials can be synthesized by in situpolymerization of acrylamide in the presence of pristine montmorillonite(MMT) or chitosan-treated MMT nanoplatelets at elevated temperature.Other elastomers may be used as well. Such a resilient polymer may alsobe combined with a mesh material or woven structure as describedelsewhere in this application.

The above summary is not intended to describe each illustratedembodiment or every implementation of the subject matter hereof. Thefigures and the detailed description that follow more particularlyexemplify various embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

Subject matter hereof may be more completely understood in considerationof the following detailed description of various embodiments inconnection with the accompanying figures, in which:

FIG. 1 is a schematic depiction of a typical prior artphacoemulsification handpiece;

FIG. 2 is a perspective view of a flexible and expandable aspiration tipaccording to an example embodiment of the invention;

FIG. 3 is a perspective partially cut-away view of a flexible andexpandable aspiration tip according to an example embodiment of theinvention;

FIG. 4 is a perspective view of a flexible and expandable aspiration tipincluding a woven structure according to an example embodiment of theinvention;

FIG. 5 is a perspective view of a flexible and expandable aspiration tipincluding a woven structure according to an example embodiment of thepresent invention;

FIG. 6A is a perspective view of a flexible and expandable aspirationtip of an example embodiment of the present invention with a tissuefragment occlusion at the distal end;

FIG. 6B is a perspective view of a flexible and expandable aspirationtip of an example embodiment of the present invention showing thelengthening of the radius of the distal end caused by an occlusion; and

FIG. 6C is a perspective view of a flexible and expandable aspirationtip of an example embodiment of the present invention showing the distalend conforming around an occlusion being aspirated.

While various embodiments are amenable to various modifications andalternative forms, specifics thereof have been shown by way of examplein the drawings and will be described in detail. It should beunderstood, however, that the intention is not to limit the claimedinventions to the particular embodiments described. On the contrary, theintention is to cover all modifications, equivalents, and alternativesfalling within the spirit and scope of the subject matter as defined bythe claims.

DETAILED DESCRIPTION OF THE DRAWINGS

Referring to FIG. 1, phacoemulsification handpiece 10 according to theprior art generally includes cutting tip 12, aspiration tube 14, andirrigation passage 16. In the depicted embodiment, irrigation passage 16generally annularly surrounds aspiration tube 14 and cutting tip 12extends outwardly beyond irrigation passage 16. Power and control unit18 supplies energy which serves to ultrasonically vibrate cutting tip12. Generally, cutting tip 12 of aspiration tube 14 according to theprior art may have a somewhat sharper edge or some structure tofacilitate cutting and removal of material.

Referring to FIGS. 2 and 3, flexible and expandable tip 20 according toan example embodiment of the invention is depicted. Flexible andexpandable tip 20 is a substantially cylindrical structure formed as ahollow tube having wall 29 defining lumen 30 therein. Flexible andexpandable tip 20 presents interior surface 26 and exterior surface 28.Interior surface 26 surrounds and defines lumen 30. Exterior surface 28covers the entire exterior circumference of flexible and expandable tip20. Flexible and expandable tip 20 includes distal end 22 and proximalend 24. Distal end 22 is cylindrically shaped and is flexible andexpandable. Distal end 22 serves as an ultrasonic cutting tip. Flexibleand expandable tip 20 is coupled to phacoemulsification device 50 atproximal end 24. Phacoemulsification device 50 is operably coupled topower, suction, and control unit 52. Power, suction, and control unit 52supplies energy which serves to ultrasonically vibrate distal end 22.Power, suction, and control unit 52 supplies suction for aspiration viaflexible and expandable tip 20.

Referring to FIGS. 3 and 4, flexible and expandable tip 20 according toan example embodiment of the invention is depicted. Generally, flexibleand expandable tip 20 includes woven structure 27. Woven structure 27 isa substantially cylindrical hollow structure having lumen 30 therein.Woven structure 27 includes interlaced material 34. Interlaced material34 can have a spiral or helical form. Interlaced material 34 can beformed of metal filaments, polymer fibers, or other suitable material ofsufficient strength and flexibility. Spiral or helical shaped interlacedmaterial 34 is woven to form woven structure 27. Interlaced material 34can be coated with or embedded in an elastomeric polymer 36. Distal end22 defines mouth of the opening 32. Mouth of the opening 32 is in fluidcommunication with lumen 30.

Referring to FIGS. 2, 4, and 5, flexible and expandable tip 20 accordingto an example embodiment of the invention is depicted. Generallyflexible and expandable tip 20 includes woven structure 27. Wovenstructure 27 presents length 40, radius of distal end 42, and angle 38between interlaced material 34. Woven structure 27 is flexible andformed in such a way that woven structure 27 can shorten along the axisof the cylinder 39 so that distal end 22 is drawn towards proximal end24. As woven structure 27 shortens along axis of the cylinder 39, length40 shortens. As woven structure 27 shortens along axis of the cylinder39, distal end 22 expands radially outward so that radius of distal end42 increases. As woven structure 27 shortens along axis of the cylinder39, an angle 38 between interlaced material 34 increases. In general,woven structure 27 is formed in such a way that distal radius 42increases as length 40 shortens. Woven structure 27 has a resilientnature so that flexible and expandable tip 20 tends to return to itsoriginal cylindrical shape following an axial shortening.

Referring to FIGS. 6A, 6B, and 6C, flexible and expandable tip 20,according to an example embodiment of the invention, is depicted.Generally, larger tissue fragment 44 can cause an occlusion at mouth ofthe opening 32. An occlusion by tissue fragment 44 can cause an increasein negative pressure inside lumen 30 generated by power, suction, andcontrol unit 52. An increase in negative pressure inside lumen 30increases a pressure differential between lumen 30 and an exterioratmosphere. Woven structure 27 is formed in such a way that a pressuredifferential increase between lumen 30 and an exterior atmosphere causeswoven structure 27 to axially shorten. Axial shortening of wovenstructure 27 causes radius 42 of distal end 22 to increase. Generally,an occlusion by tissue fragment 44 causes radius 42 of distal end 22 toincrease. Lengthening of radius 42 facilitates aspiration of tissuefragment 44. The flexible and expandable nature of distal end 22 allowsdistal end 22 to conform around an tissue fragment 44 while an tissuefragment 44 is aspirated. Distal end 22 conforming around tissuefragment 44 while tissue fragment 44 is aspirated further facilitatesaspiration of tissue fragment 44.

The invention further includes an example method of mitigating surges offlow into and through an aspiration channel during a phacoemulsificationprocess. The method includes utilizing a phacoemulsification cutting tiphaving a flexible and expandable tip portion; making contact between theflexible and expandable tip portion and a crystalline lens of the eye orfragments of the crystalline lens of the eye; and utilizing anaspiration flow and negative pressure that facilitates radial expansionof the flexible and expandable tip portion upon blockage of an openingof the flexible and expandable tip portion by the fragments of thecrystalline lens of the eye.

The invention further includes an example method of phacoemulsification,including contacting a crystalline lens of an eye with aphacoemulsification tip having a distal expandable portion and aproximal rigid portion; and increasing a radius of the expandableportion while shortening and axial length of the expandable portionunder negative pressure upon a blockage of an opening of the distalexpandable portion; whereby aspiration of crystalline lens fragments isfacilitated.

In operation, phacoemulsification device 50 equipped with flexible andexpandable tip 20 is applied through an incision in the eye and througha capsulorhexis opening made in the lens capsule of an eye to thecrystalline lens therein. Typically, the crystalline lens will beaffected by a cataract though clear lens extraction is sometimesperformed. When distal end 22 is contacted against a crystalline lens ofthe eye, ultrasonic vibration of distal end 22 can cause tissue tofragment. Power, suction, and control unit 52 supplies vacuum toflexible and expandable tip 20 to facilitate the aspiration of fluid andtissue fragments separated from the crystalline lens by distal end 22via lumen 30 and mouth of the opening 32.

According to another example embodiment of the invention,flexible/expandable tip 20 is made at least partially of a resilientpolymer or elastomeric. According to this example embodiment, when theradius of distal end 42 of flexible/expandable tip 20 increases the wall29 of the flexible/expandable tip become thinner thus accommodating theexpansion. Acrylic/ethylene copolymers (AEM) fluoroelastomers (FKM) andperfluoroelastomers (FFKM) such as those manufactured by DuPontCorporation can be utilized. For example, neoprene, Viton®, Varnac®ethylene acrylic elastomer, ethylene methyl acrylate copolymer with curesite monomer or Kalrez® (FFKM) elastomer may prove useful. According toanother example embodiment, flexible/expandable tip 20 can be formedfrom a highly stretchable and highly resilient polymer-claynanocomposite hydrogel. Such materials can be synthesized by in situpolymerization of acrylamide in the presence of pristine montmorillonite(MMT) or chitosan-treated MMT nanoplatelets at elevated temperature.Other elastomers may be used as well. Such a resilient polymer may alsobe combined with mesh material, interlaced material or woven structure27 as described elsewhere in this application.

In operation, tissue fragments can be drawn into lumen 30 foraspiration. It is expected that during operation, increasing of radius42 of distal end 22 will increase the likelihood that fragments of thecrystalline lens will be drawn into lumen 30 for more efficientaspiration than in a conventional phacoemulsification aspiration tube14. Furthermore, more efficient aspiration of tissue fragments willreduce interference with the surgeon's ability to see the lens and otherstructures of the eye.

Various embodiments of systems, devices, and methods have been describedherein. These embodiments are given only by way of example and are notintended to limit the scope of the claimed inventions. It should beappreciated, moreover, that the various features of the embodiments thathave been described may be combined in various ways to produce numerousadditional embodiments. Moreover, while various materials, dimensions,shapes, configurations and locations, etc. have been described for usewith disclosed embodiments, others besides those disclosed may beutilized without exceeding the scope of the claimed inventions.

Persons of ordinary skill in the relevant arts will recognize that thesubject matter hereof may comprise fewer features than illustrated inany individual embodiment described above. The embodiments describedherein are not meant to be an exhaustive presentation of the ways inwhich the various features of the subject matter hereof may be combined.Accordingly, the embodiments are not mutually exclusive combinations offeatures; rather, the various embodiments can comprise a combination ofdifferent individual features selected from different individualembodiments, as understood by persons of ordinary skill in the art.Moreover, elements described with respect to one embodiment can beimplemented in other embodiments even when not described in suchembodiments unless otherwise noted.

Although a dependent claim may refer in the claims to a specificcombination with one or more other claims, other embodiments can alsoinclude a combination of the dependent claim with the subject matter ofeach other dependent claim or a combination of one or more features withother dependent or independent claims. Such combinations are proposedherein unless it is stated that a specific combination is not intended.

Any incorporation by reference of documents above is limited such thatno subject matter is incorporated that is contrary to the explicitdisclosure herein. Any incorporation by reference of documents above isfurther limited such that no claims included in the documents areincorporated by reference herein. Any incorporation by reference ofdocuments above is yet further limited such that any definitionsprovided in the documents are not incorporated by reference hereinunless expressly included herein.

For purposes of interpreting the claims, it is expressly intended thatthe provisions of 35 U.S.C. § 112(f) are not to be invoked unless thespecific terms “means for” or “step for” are recited in a claim.

The invention claimed is:
 1. A phacoemulsification cutting tip,comprising: a rigid tubular portion and a flexible and expandable tipportion located distal to the rigid tubular portion; the flexible andexpandable tip portion defining a distal opening at a distal endthereof; and the flexible and expandable tip portion presenting an axiallength and an unexpanded radius and being shiftable between the extendedaxial length and the unexpanded radius and a shortened axial length andexpanded radius when subject to differential pressure due to anocclusion of the distal opening; whereby aspiration of crystalline lensfragments is facilitated.
 2. The phacoemulsification cutting tip asclaimed in claim 1, wherein the flexible and expandable tip portionfurther comprises a woven structure.
 3. The phacoemulsification cuttingtip as claimed in claim 2, wherein the woven structure further comprisesa cylindrical, helically wound, biaxial braid.
 4. Thephacoemulsification cutting tip as claimed in claim 2, wherein the wovenstructure further comprises a spiral or helix shaped material.
 5. Thephacoemulsification cutting tip as claimed in claim 1, wherein theflexible and expandable tip portion further comprises metal filaments,polymer fibers, polyaramid or para-aramid.
 6. The phacoemulsificationcutting tip as claimed in claim 1, wherein the flexible and expandabletip portion further comprises an elastomeric material or a resilientmaterial, wherein the elastomeric material or the resilient materialbiases the flexible and expandable tip portion toward the extended axiallength and the unexpanded radius.
 7. The phacoemulsification cutting tipas claimed in claim 1, wherein the flexible and expandable tip portionfurther comprising helix shaped material interlaced to form a wovenstructure.
 8. A method of mitigating surges of flow into and through anaspiration channel during a phacoemulsification process, the methodcomprising: utilizing a phacoemulsification cutting tip having aflexible and expandable tip portion; making contact between the flexibleand expandable tip portion and a crystalline lens of the eye orfragments of the crystalline lens of the eye; and utilizing anaspiration flow and negative pressure that facilitates radial expansionof the flexible and expandable tip portion upon blockage of an openingof the flexible and expandable tip portion by the fragments of thecrystalline lens of the eye.
 9. The method as claimed in claim 8 furthercomprising, making or selecting the phacoemulsification cutting tipflexible and expandable tip portion to include a woven structure. 10.The method as claimed in claim 8 further comprising, making or selectingthe phacoemulsification cutting tip flexible and expandable tip portionto include a cylindrical, helically wound, biaxial braid.
 11. The methodas claimed in claim 8 further comprising, making or selecting thephacoemulsification cutting tip flexible and expandable tip portion toinclude a spiral or helix shaped material.
 12. The method as claimed inclaim 8 further comprising, making or selecting the phacoemulsificationcutting tip flexible and expandable tip portion to include anelastomeric material or a resilient material that biases the flexibleand expandable tip portion toward the extended axial length and theunexpanded radius.
 13. The method as claimed in claim 8 furthercomprising, making or selecting the phacoemulsification cutting tipflexible and expandable tip portion to include helix shaped materialinterlaced to form a woven structure.
 14. A method ofphacoemulsification, comprising: contacting a crystalline lens of an eyewith a phacoemulsification tip having a distal expandable portion and aproximal rigid portion; and increasing a radius of the expandableportion while shortening and axial length of the expandable portionunder negative pressure upon a blockage of an opening of the distalexpandable portion; whereby aspiration of crystalline lens fragments isfacilitated.
 15. The method as claimed in claim 14 further comprising,making or selecting the phacoemulsification cutting tip flexible andexpandable tip portion to include a woven structure.
 16. The method asclaimed in claim 14 further comprising, making or selecting thephacoemulsification cutting tip flexible and expandable tip portion toinclude a cylindrical, helically wound, biaxial braid.
 17. The method asclaimed in claim 14 further comprising, making or selecting thephacoemulsification cutting tip flexible and expandable tip portion toinclude a spiral or helix shaped material.
 18. The method as claimed inclaim 14 further comprising, making or selecting the phacoemulsificationcutting tip flexible and expandable tip portion to include anelastomeric material or a resilient material that biases the flexibleand expandable tip portion toward the extended axial length and theunexpanded radius.
 19. The method as claimed in claim 14 furthercomprising, making or selecting the phacoemulsification cutting tipflexible and expandable tip portion to include helix shaped materialinterlaced to form a woven structure.